Management of people with low back pain: a survey of opinions and beliefs of Dutch and Belgian chiropractors

Abstract

Background Chiropractors commonly provide care to people with low-back pain (LBP). The aim of this survey was to determine the opinions and beliefs of chiropractors regarding the support and management of LBP. We also investigated whether their management is in accordance with the three most commonly recommended approaches to LBP based upon international guidelines (i.e. advice regarding return-to-work, limit bedrest, and stay active). Methods A web-based survey was sent out in 2013 to collect data from registered Dutch and Belgian chiropractors. In addition to providing a description of their sociodemographic and practice characteristics, chiropractors were asked to complete six patient vignettes representing people with LBP who typically present to a chiropractor. The respondents indicated which intervention(s) they would recommend or undertake. Based upon these vignettes, we were able to determine whether their management approach adhered to clinical guidelines. Generalized mixed models were used to explore guidelines adherence and their relationship to chiropractors’ characteristics. Results In total, 60% (n = 203/340) of the chiropractors who were invited, chose to participate. Chiropractors reported applying a chiropractic adjustment in 90% of all vignettes, while the advice to exercise varied from one-third in the chronic cases to approximately half of those with acute LBP. More than 75% of the chiropractors would initially treat LBP 1–2 times a week. More than 90% of the chiropractors advised against bedrest. Overall, self-reported adherence to clinical guidelines for all six vignettes was [64.5% (CI 58.7–70.0)]. Adherence in the chronic vignettes [73.4% (CI 66.7–79.2)] was better than in the acute vignettes [55.9% (CI 50.5–61.1)]. Importantly, regarding recommended approaches to LBP, chiropractors more consistently followed guidelines regarding advice to limit bedrest [98.5% (CI 97.3–99.1)] than advice to stay active [77.5% (CI 72.3–81.9)] or return-to-work [59.4% (CI 55.2–63.4)]. Finally, Dutch chiropractors were more likely to adhere to the guidelines than Belgian chiropractors. Conclusions Chiropractic adjustments were the most common self-reported treatment modalities supplemented by exercise in the management of LBP patients. Two-thirds of the chiropractors reported adhering to the guidelines regarding management and advice for LBP patients. Practitioners should improve guideline adherence, particularly for acute LBP cases, and when advising on return-to-work.

Is the use of diagnostic imaging and the self-reported clinical management of low back pain patients influenced by the attitudes and beliefs of chiropractors? A survey of chiropractors in the Netherlands and Belgium

“…The overall adherence to guidelines based on the vignettes has been described in two previous articles. Summarising, the majority of the respondents adhered well to the LBP guidelines and to the diagnostic guidelines [ 26 , 27 ]. Adherence on advice on bedrest was 98,5% in all vignettes [ 26 , 27 ].…”

“…Summarising, the majority of the respondents adhered well to the LBP guidelines and to the diagnostic guidelines [ 26 , 27 ]. Adherence on advice on bedrest was 98,5% in all vignettes [ 26 , 27 ]. Adherence to guidelines in acute patient vignettes was lower (39.4- 68.2%) than in chronic patient vignettes (62.3–83.8%).…”

Can you be a manual therapist without using your hands?

“…Manual therapists such as chiropractors define themselves by the physical clinical encounter with a patient and primarily rely on hands-on approaches. Over the years, however, most have added other strategies such as exercise and pain education to their toolbox, evolving to more complete and guideline-based care offered to their patients [ 7 ]. We suggest it is time they also add telehealth to that toolbox.…”

Is the use of diagnostic imaging and the self-reported clinical management of low back pain patients influenced by the attitudes and beliefs of chiropractors? A survey of chiropractors in the Netherlands and Belgium

“…). Adherence on advice on bedrest was 98,5% in all vignettes(8,23). Adherence to guidelines in acute patient vignettes was lower (39.4-68.2%) than in chronic patient vignettes (62.3-83.8%).Results from the vignettes suggest that chiropractors in the high biomedical class better adhered to diagnostic imaging guidelines (71.5%) compared to the other two groups (mid biomedical class: 69.1% and low biomedical class: 49.2% respectively) (Table4a).…”